In just a few weeks, my classmates and I will participate in what has become a medical right of passage: the white coat ceremony. The white coat ceremony commemorates the formal presentation and cloaking of the white lab coat for medical students.

What is the meaning of the white coat, and how did it earn its emblematic status in the health professions? In this first part of two, I’ll be discussing what I learned about its the white coat ceremony’s history and meaning. After our own white coat ceremony on 12/10/2010, I’ll post part 2, in which we’ll share our personal experiences with the event.

Before the White Coat Ceremony

Black coats were originally used to dissect cadavers, as a sign of respect for the dead. White later became the preferred color because it symbolized cleanliness, purity, and righteousness, did not fade when washed at high (germ-killing) temperatures, and any soiling was easily noticed.

White coats have been the most prominent symbol of the physician since the development of aseptic surgery in the U.S. in about 1889. Surgeons at Massachusetts General Hospital can be seen wearing them in photographs of surgeries. They were worn in an effort to prevent patients and physicians from contaminating each other. Ironically, the doctors in these photos aren’t wearing gloves or masks, as they were not yet accepted in the field.

By the early 20th century, health care had moved from patients’ homes into hospitals. Limited infection control measures, unfamiliar surroundings, and unproven treatments often made the public reluctant to access the care that was available to them in hospitals. To enhance its credibility and reassure the public that hospitals and doctors were indeed safe, the medical profession began to associate itself with science, a field that had begun to earn the public’s respect and trust. Science had built the Panama Canal, invented the telephone, and made possible the first human flight. Linking medicine with science began to soften the pubic distrust. By 1920, the white coat had become a powerful and iconic symbol of the physician as medical scientist.

During the early 20th century, the public trusted scientists more than doctors.

White coats have plenty of critics – chief among them, some doctors. Most surveys of doctors show that they would prefer not to wear them because they are hot, expensive to launder, and can intimidate patients. Unfortunately for these doctors, studies of patients usually find that they prefer their physician to wear one.

” White Coat Hypertension” refers to the well documented observation that 15-30% of patients are mildly hypertensive while in the clinical setting, but show no elevation in blood pressure in other settings. The cause has not been proven, but it is thought to be related to the anxiety that patients feel when in clinical settings.

Some feel that the use of white coats by clinicians perpetuates an unhealthy power dynamic that invites the patient to idealize the clinician and devalue their own knowledge. There have been recent movements to end the use of white coats in medicine because of the power it has come to represent, and to reduce the spread of infection that many assume occurs when clinicians wear the same coat to see different patients. To curb infection that may be spread this way, some nations (notably Great Britain) have switched to short-sleeved coats. Ireland has banned them altogether, along with jewelry and neck ties. The American Medical Association considered banning them in 2009, but stopped because of a “lack of scientific evidence.”

For years, doctors wore white coats of differing lengths, according to personal taste and the traditions of the hospitals in which they worked. There are no hard and fast rules, but the trend is to associate the shorter, hip-length coats with those in training. For most, the longer coat is seen as more fashionable, and therefore its use is only earned with time. At some hospitals, such as Massachusetts General, all physicians wear the short coat to symbolize their status as lifelong learners. In other hospital systems, coat length is a very accurate indicator of medical status — the longer the coat, the higher the status and experience of its wearer.

The White Coat CeremonyToday

A modern medical right of passage

The white coat ceremony is a recent development, originating at Columbia University’s College of Physicians and Surgeons in 1993, and has since expanded to other health professions, including physician assistants and pharmacists, and schools of medicine outside the U.S. The white coat ceremony was developed by Arnold P. Gold, M.D., who sought to bring a humanistic focus to medicine. According to Dr. Gold, “A physician’s responsibility is not only to take care of patients, but also to care for patients.”

Because of the power dynamic implied by the white coat, some schools have switched from a white coat ceremony to a stethoscope ceremony. Instead of presenting a coat to the student, a stethoscope is placed on the shoulders of the novitiate. The act is meant to symbolize the gift of something that will connect doctor and patient, rather than something that will separate them.

Today the white coat ceremony has become a common tradition in most medical and physician assistant schools, as well as other schools of advanced medical training. There are many variations, but perhaps the most common is to hold the white coat ceremony when the student begins working with patients in hospitals, since this is usually a departure from the heavily text-and-lecture-dependent early training to more practical clinical training.

This was really interesting, thanks for sharing! I never even thought about/noticed the different coat lengths, but that makes sense. Personally I think I will always be most comfortable in scrubs or normal clothes- while the symbolism of the ceremony will be meaningful, I hope to ditch the coat when I’m working, LOL!

I’ve linked your blog on mine since you have so much information on here. If you want it removed for any reason, don’t hesitate to ask!

Beautiful ceremony! it is a pity that the beauty of the white coat (lab / ward coat) is fading, because medically enlightened people are using it in an unhealthy manner: now becoming source of transmitting infection from clinical to non clinical environment such as food canteen, banks even day care centers etc.

I agree. Thankfully, those professions NEVER seem to use the full length lab coat that fully licensed medical providers wear. In fact, I don’t see long coats on pharmacists or other allied health professions. I pretty much only see them on physicians, PAs, and NPs. Hopefully it will stay that way…

It was interesting to read of the symbolic importance and history of an article of clothing I’ve taken for granted in another profession. Full length white or navy lab coats were always available as a protective measure from the time I was training in other scientific labs (food chemistry, geology, forensic, materials science) and worn by students, interns, technicians, through PhD-level staff scientists or professors actively doing bench work. This was never part of one’s professional image or interaction with the public as most of these labs were extremely restricted in access, but we’d regularly change coats to prevent cross-contamination between samples from different sources, different cases or projects, or to simply avoid getting a mess on our regular clothing. I guess that’s why a clean lab coat isn’t intimidating to me in the least but I can appreciate what it means in the medical science profession from this article.

We just received an invite to a “White Coat Ceremony” at Samford University where our granddaughter is in college and nurses training. I searched for information re an appropriate gift and was amazed at all I learned, including information that this ceremony began at Columbia University not long ago. I worked at that hospital in the 1960’s.

I have to thank you so much for this incredibly informative site. I’ve spent hours reading through all of the knowledge that you share. Thank you, thank you, for pouring out so much of yourself to so many people!

Jamie

Your page is amazing! I have referred others who want to become PA’s to it because it has so much information

Tiffany

Pure gold!! You never cease to amaze, Paul. I loved every part of this article, it was exactly what I was looking forward to reading! you rock sir! :) Also, great job on the app, it’s fantastic!